Association between device-measured physical activity and lumbar Modic changes

New-Occurrence of Postoperative Modic Changes and Its Influence on the Surgical Prognosis After Percutaneous Endoscopic Lumbar Disc Discectomy

OBJECTIVES

Lumbar disc herniation (LDH) is a common degenerative spinal disease in clinical practice. This study aims to investigate the impact of Modic changes (MCs) on postoperative recovery and disease recurrence following percutaneous endoscopic lumbar disc discectomy (PELD), providing important insights for improving the management of chronic low back pain. This study investigates the 1-year progression rate of MCs after PELD and their impact on surgical outcomes and recurrence.

METHODS

This retrospective cohort study analyzed data from 419 patients with single-segment lumbar disc herniation who underwent PELD between January 2019 and December 2022. Lumbar MRI assessed preoperative and postoperative MCs. Pain levels and surgical outcomes were evaluated using the visual analog scale, Oswestry Disability Index, and Macnab criteria. Univariate analysis explored the relationship between postoperative MCs and pain, while subgroups investigated the associations between postoperative efficacy, recurrence, and MCs type and area.

RESULTS

One-year follow-up revealed that the probability of MCs postsurgery was 24.8%. Patients with postoperative MCs had significantly lower pain scores compared with the control group (p < 0.05). Univariate analysis indicated that the type and area of postoperative MCs were risk factors for poor outcomes in PELD patients (p < 0.05). During the 1-year follow-up, recurrence rates in the no-MCs and MCs groups were 3.8% and 9.6%, respectively (p < 0.05). Univariate analysis concluded that the area of postoperative MCs was a risk factor for PELD recurrence.

CONCLUSION

The postoperative MCs, as a risk factor, may have a detrimental effect on the surgical efficacy and short-term recurrence of LDH following PELD based on a large sample. Furthermore, the harmful effect is affected by the area and type of the postoperative MCs.

Modic changes as seen on MRI are associated with nonspecific chronic lower back pain and disability

BACKGROUND

Estimating the contribution of endplate oedema known as Modic changes to lower back pain (LBP) has been the subject of multiple observational studies and reviews, some of which conclude that the evidence for an association of Modic change with LBP is uncertain while others demonstrate a clear link. The clinical trials demonstrating the benefit of basivertebral nerve ablation, a therapeutic intervention, in a tightly defined homogenous patient group with chronic LBP and Modic changes type 1 or type 2, provides further evidence for the contribution of Modic changes to LBP and shows that in these subjects, nerve ablation substantially reduces pain and disability. These interventional studies provide direct evidence that Modic changes can be associated with lower back pain and disability. This review set out to explore why the literature to date has been conflicting.

METHODS

A narrative, forensic, non-systematic literature review of selected articles to investigate why the published literature investigating the association between Modic imaging changes and chronic low back pain is inconsistent.

RESULTS

This review found that previous systematic reviews and meta-analyses included both heterogeneous study designs and diverse patient syndromes resulting in an inconsistent association between Modic changes and nonspecific chronic lower back pain. Re-analysis of literature data focussing on more homogenous patient populations provides clearer evidence that Modic changes are associated with nonspecific chronic lower back pain and that type 1 Modic changes are more painful than type 2.

CONCLUSIONS

Studies using tightly defined homogenous patient groups may provide the best test for association between MRI-findings and pain and disability. Clinical benefit of basivertebral nerve ablation observed in randomised controlled trials further supports the association between type 1 and type 2 Modic changes with pain and disability.

Association Between Vertebral Dimensions and Lumbar Modic Changes

STUDY DESIGN

Population-based birth cohort study.

OBJECTIVE

The aim of this study was to evaluate the relationship between vertebral dimensions and lumbar MC.

SUMMARY OF BACKGROUND DATA

Low back pain (LBP) has become the leading cause of disability worldwide. Modic changes (MC) of the lumbar spine are one potential LBP-associated etiological factor. Mechanical stress is considered to play a key role in the development of MC through damage to endplates. There is speculation that vertebral dimensions play a role in some degenerative changes in the spine. Previous studies have also shown a positive association between moderate-to-vigorous physical activity (MVPA) and both vertebral dimensions and MC. In this study, we aimed to evaluate the relationship between vertebral dimensions and MC.

METHODS

The study population consisted of 1221 participants from the Northern Finland Birth Cohort 1966 who underwent lumbar magnetic resonance imaging (MRI) and physical activity measurements at the age of 46-48. The presence of Type 1 (MC1) and Type 2 (MC2) MC and the height, axial cross-sectional area (CSA), and volume of the L4 vertebra were determined from MRI scans. MVPA (≥3.5 metabolic equivalents) was measured by a wrist-worn accelerometer. We analyzed the association between lumbar MC and vertebral height, CSA, and volume using logistic regression models before and after adjustment for sex, height, weight, smoking, education level, and MVPA.

RESULTS

Vertebral height was positively associated with the presence of MC2 (odds ratio [OR] 3.51; 95% confidence interval [CI] 1.43-8.65), whereas vertebral CSA was not associated with the presence of lumbar MC. Vertebral volume was positively associated with the presence of any MC (OR 1.04; 95% CI 1.00-1.07), but the association did not persist when analyzing MC1 and MC2 separately.

CONCLUSION

Vertebral height was associated with the presence of MC2. Further studies are needed to clarify the role of vertebral dimensions as independent risk factors for MC.Level of Evidence: 3.